Alaska Native Tribal Health Consortium Business Resource Center NEWSLETTER Services Provided by the Business Resource Center • • Coding • CODING • CODING • Yes, we can code for you! • Coding Audits • Medical & Dental Billing Support • Coding & Billing Mentoring BRC MISSION STATEMENT To support, educate and train members of the Alaska Tribal Health System in coding, reimbursement and revenue cycle management, thereby empowering tribal facilities to sustain their operations and improve cash flow. GET READY FOR NEW ICD-9-CM CODES OCTOBER 1 206 NEW CODES 55 REVISED CODES AND 28 DELETED CODES September 30, 2006 A 50 year old male presents to clinic with the need to urinate frequently during the night, but with inability to urinate. Blood is drawn for PSA. Results show elevated PSA levels. The provider performs a digital rectal exam of the prostate and a diagnosis of acute prostatitis is made. The provider recommends the patient undergo a biopsy of the prostate. Patient agrees and appointment is scheduled for the following day. What are the correct ICD-9-CM codes for this visit? (Customized, on-site) Analysis of accounts receivable Volume 12, Issue 1 SEPTEMBER IS PROSTATE CANCER AWARENESS MONTH Business Office Training to include medical billing, dental billing and oversight. • Business Office and Coding Support A. 601.0; 790.93; B. 788.41; V13.09; 601.0 C. V76.44; 601.0 Answer on page 3 Who needs to know about Prostate Cancer? All men need to be Real Men and know about prostate cancer and take a greater interest in their general health. Prostate cancer is the most common form of cancer in men - finding out about it could save your life. The risk of getting prostate cancer gets higher as you get older. Most men are diagnosed over the age of 50, but it can affect men from the age of about 40. You are two and a half times more likely to get prostate cancer if your father, brother or son has been diagnosed. The risk is also higher if you are of African American background. However, prostate cancer does not just affect men - it also affects their friends and family. During Prostate Cancer Awareness Week it's important that information about this disease reaches as many people as possible, so that we can all help our fathers, grandfathers, uncles, brothers, sons, husbands and partners know about it. 1 Volume 12, Issue 1 To Code or Not to Code: That is the question…. Article this month is by Kevin Maier CPC. Coder’s Corner Happy Fall everyone. At this time of year I’m sure that a few of you out there are seeing some coding situations related to seasonal related physical exams. Quite often they are called things like “Sports Physicals” or “School Physicals” and you may be wondering what codes should be used? These exams are preventative in nature but often times they don’t meet the requirements for coding the Preventative service codes. Even so the AMA states that the Preventative Service codes are to be used only when the History, Physical and Examination are “Comprehensive”. While this is well and good the CPT book doesn’t supply clear guidelines about how to code these visits if the requirement of “Comprehensive” is not met. This is where we find ourselves looking to other resources to come up with clear consistent guidelines for our facility. The AMA has officially addressed the issue of such "sports physicals" on three separate occasions: the first was in the July 1996 issue of The CPT Assistant, the second was in the August 1997 issue of The CPT Assistant, and the third was in the 1999 edition of The CPT Companion book. Here are the sightings: CPT Assistant July 1996: Question: What code should I use to report a "sports" physical? AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the Preventive Medicine series. If the physician performs a brief, detailed, or extended history and examination, then report the appropriate level office or other outpatient evaluation and management visit code. CPT Assistant August 1997: Question: What code should I use to report a "sports physical" or a "school physical?" If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the appropriate level office or other outpatient evaluation and management visit code. The CPT Companion book 1999: Question: What code should I use to report a "sports" physical? AMA Comment: If the physician performs a comprehensive history and examination, then you should report the age appropriate code from the preventive medicine series. If the physician performs a problem focused, expanded problem focused or detailed history and examination, then report the appropriate level office or other outpatient evaluation and management visit code. Now keep in mind that these articles address specifically “sports physicals”. But in essence the guidelines should be applied to any preventative services that do not meet the requirements of the preventative service codes. Have a great Fall and remember to think healthy both physically and fiscally. KEVIN AND CHERI NEED A BREAK! CONTEST! Would you like to be the author of next month’s Coding Article? Would you like to come up with next month’s Coding Quiz question/answer? Do you have a question that needs an answer? Submit your stuff to [email protected] and the winners will get an E/M Coding Wheel! Please send a picture of yourself if you have it and we’ll publish your photo along with your winning submission and you will be FAMOUS! ANOTHER GREAT WEBSITE THAT YOU SHOULD CHECK OUT IS www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp There are some great “cheat sheets” for coding preventive services and immunizations! 2 Volume 12, Issue 1 10 THINGS EVERYONE SHOULD KNOW ABOUT PROSTATE CANCER 1. 1 in every 6 men will get prostate cancer sometime in his life. Over 234,460 new cases are expected this year—more than breast cancer. 2. The chances of getting prostate cancer are 1 in 3 if you have just one close relative (father, brother) with the disease. The risk is 83% with two close relatives. With three, it’s almost a certainty (97%). 3. African American men are at special risk for the disease, with the highest rate of prostate cancer in the world: 1 in 4 men. African American men are 2.5 times more likely to die from the disease. 4. Prostate cancer is the second-leading cause of cancer-related death in the US. 5. There are no noticeable symptoms of prostate cancer while it is still in the early stages. This is why screening is so critical. 6. Every man age 50 or over should resolve to be screened annually. African American men or those with a family history of the disease should start annual screening at 40. 7. Before early detection through PSA screening, only 1 in 4 prostate cancer cases were found while still in the early stages. With the widespread use of screening, about 9 out of 10 cases are now found early—giving men a fighting chance. 8. Nearly 100% of men diagnosed with prostate cancer while it is still in the early stages are still alive 5 years from diagnosis. Of men diagnosed in the late stages of the disease, 33.4% survive 5 years. 9. Screening for prostate cancer involves a simple blood test and a physical exam. It takes about 10 minutes and is covered by most health insurance. 10. Obesity is a significant predictor of prostate cancer severity. Research levels show high cholesterol levels are strongly associated with advance prostate cancer. www.FightPRostateCancer.org Answer to coding quiz from page 1: The correct answer is A. 601.0—Acute Prostatisis; 790.93—Elevated PSA. Cheri’s Coding Quiz is developed each month by the BRC’s Cheri Carter, CPC Medicaid Task Force FORUM meetings are being held every other week to discuss proposed changes to existing Medicaid policy specific to the tribes in Alaska. For more information, please contact Gwen Obermiller at: [email protected] UPCOMING EVENTS The Alaska Chapter of the American Academy of Professional Coders (AAPC) is hosting their semi-annual educational seminar on Saturday, October 28 at the Senior Center in Anchorage. Cheri Carter, CPC is on the planning committee, so call her (907-729-2894) for more information. 3 Volume 12, Issue 1 PROSTATE CANCER CODES IN THE KNOW V16.42 FAMILY HISTORY PROSTATE CANCER V10.46 PERSONAL HISTORY PROSTATE CANCER V13.09 PERSONAL HISTORY URINARY SYSTEM DISORDER V76.44 SPECIAL SCREENING FOR MALIGNANT NEOPLASMS-PROSTATE 595.2 600.00 OTHER CHRONIC CYSTITIS HYPERTROPY (BENIGN) OF PROSTATE WITHOUT URINARY OBSTRUCTION 602.3 DYSPLASIA OF PROSTATE 601.0 PROSTATITIS 185 MALIGNANT NEOPLASM PROSTATE G0102 SCREENING PROSTATE CANCER DIGITAL RECTAL (MEDICARE) G0103 PROSTATE SPECIFIC ANTIGEN TEST (PSA) S0605 DIGITAL RECTAL EXAM, ANNUAL (NON-MEDICARE) SCREENING VS DIAGNOSTIC Screening—Patient has no abnormality or symptom Family history can be coded if documented Diagnostic—Patient has an abnormality or symptoms The symptom or abnormality is coded If any test results are available, code the definitive diagnosis CHECK OUT THESE WEBSITES www.prostatecancerfoundation.org www.prostatecommons.com www.prostateinfo.com www.healthcentral.com 4